Essay: Music Therapy Vs Touch Therapy In Treating Anxiety In Elderly Dementia Patients.

Discuss about the Effect of therapeutic touch on verbal and physical aggression in elderly patients with dementia.

Rationale for Choosing the Topic

Dementia is a global issue giving rise to high prevalence rate ad limitations of the drug effects. In most of the cases pharmacological interventions often brings about adverse drug reactions and other conditions such as delirium, constipation and other health issues. Due to this reason, the non-pharmacological interventions are of utmost importance (Vasionyt? and Madison 2013). Complementary treatments such as music therapies, massage and touch therapy has been found to be effective in minimising agitation in the elderly dementia patients.

Although both touch therapy and music therapy are considered as alternative treatment options for mitigating agitation and anxiety in the elderly dementia patient. This paper would exclusively compare the effectiveness of the music therapy and the touch therapy that can be

 Helpful in future nursing practice to introduce music therapy in the clinical nursing.

All the key points has been arranged in the following order-

All the papers will be chosen will concentrate on elderly dementia patients and would not take in to consideration the other comorbidities associated to anxiety in the dementia patients in hospitals or residential care or institutionalised settings. The literature review will be based only on the basis of the English articles between the years. All the papers that has been chosen are quantitative studies based upon the effect of music therapy and touch therapy in the dementia patients.

In this paper it will be argued that music therapy is more effective than touch therapy in treating anxiety in elderly adults with dementia.

Dementia is a common chronic condition that is due to degeneration of the brain tissues. Prevalence of agitation and anxiety in the dementia patients in common irrespective of whether they are staying up at home or are institutionalised (Ridder et al., 2013). However treatment of the agitated behaviour of the patients can be done by both pharmacological and non-pharmacological interventions. However, drug interventions are much limited and are accompanied by several side effects that increases the mortality in the patients, increased prevalence of cerebrovascular accidents and increasing the declination of the cognitive functions. Hence non pharmacological interventions are being tried in a wide number of nations to treat the elderly dementia patient with agitation and anxiety. Hence several complimentary therapies such as music therapy, massage therapy, pet assisted therapy are in vogue, for treating dementia patients. However, researches are still going on regarding the validity of these treatments or their advantage over the antidepressant medicines with respect to cost and side effects. Among the various complementary therapies, many researches have been done in order to prove the effectiveness of music therapy over other complementary therapies (Ridder et al., 2013). Music therapy has been found to enhance the sensory wellbeing by the reduction of the agitation, anxiety and depression. Music containing meaningful lyrics can trigger memories that are connected to their life.  The main rationale for this topic is that such a research work would be able to quest the truth behind the use of the complementary therapies. Such practices can also have future nursing implications as music therapies can be introduced as a part of the nursing interventions in clinical settings can also be used as treatment options as music can evoke emotions and might help the patient in recalling his/her loved ones.  

Designing a Clinical Question

Evidence based practice can be defined as the use of the best current practices to make suitable clinical decisions. There are currently no standard formula of how the credibility of the factors be weighed in the clinical decision making process. There are several of rating systems or hierarchy to understand the strength and the quality of the research. The evidence obtained from the randomised control trials, meta-analysis and various clinical practice guidelines based on the systematic reviews of the RCTs are taken as the highest levels of evidence (Aigen 2015). Hence, we would exclusively focus upon the randomised trials and cohort studies to find out the effectiveness of music therapy over touch therapy in the dementia patients. In most of the cases the RCTs determine the whether the anxiety level has been decreased after the music interventions or not.

In elderly patients with dementia, is music therapy, compared with touch therapy, more effective in reducing anxiety? 

Source: Created by the author

The search strategy can be referred to as the creation of the organised structure by the use of some essential search terms that has been fed in to three electronic databases. PubMed, CINAHL and MEDLINE has been used for retrieving the articles. According to Parahoo (2014) before the initiation of a systematic review, it is important to conduct a detailed search of the articles available on these databases. These databases has been chosen because they provide a wide variety of nursing articles based on this topic.

Source: Created by the author

Source: Created by the author

It has to be mentioned in this context that the RCT articles are considered to be the highest level of evidence due to the fact that RCTs have a first-hand experience of the experiments and helps in obtaining most statistically significant results pertaining to the lowest p-value. Hence, for this quantitative review of evidence, RCT and pilot studies of RCT design has been selected.

Sung et al. (2012) in their article have mentioned that group music intervention taking the assistance of the percussion instruments of the familiar music is much more effective in reducing the level of anxiety and agitation in the dementia patients. This experimental study followed the research design of a randomized control trial involving 60 older adult participants suffering from dementia that were randomly assigned to a control and an experimental group. The intervention that has been used in the article has been a 30-min music intervention that utilizes the aid of percussion instrument and the intervention was given to the experimental group in mid-afternoon twice a week for 6 consecutive weeks. The assessment instruments used to obtain and contrast the data findings had been the rating of anxiety in dementia scale along with Cohen Mansfield agitation inventory. The results or the data findings indicated that the experimental group with the older adults that received the music intervention had significantly lower anxiety score at F = 8.98, p = 0.004 being the pre-test score and cognitive level. Along with that, it has to be mentioned that the agitation level of the patients in the experimental and control group has been resulted to not being significantly statistically different at all. Hence, it can be understood from the data that although the article could prove that music therapy is a cost effective and easy method to reduce the level of anxiety in the older adults with dementia, however, there is not much details in how the music therapy acts on agitation levels of the patient (Sung et al. 2012).

Evidence-Based Practice Using PICO Tables

Similarly, the article by Chu et al. (2014) aimed to determine whether the music therapy is efficient in reducing the levels of depression in elderly dementia patients and whether it can delay the deterioration of the cognitive functioning of the elderly people with dementia. This randomized control trial utilized the prospective, parallel group design with permuted block randomization of 104 participants who were randomly assigned to experimental and control groups. The intervention in this case had also continued for 6 weeks which involved 12 sessions of music therapy as well although the authors had not mentioned extensive details of the music therapy other than the fact that it had been group music therapy. The results indicated that the group music therapy had been effective in reducing the levels of depression among the elderly patients effectively and the improvements also was reported to occur immediately after the music therapy intervention was given which improved consecutively throughout the course of the therapy. The mean CSDD scores for the experimental group trended downward, from 17.39 at baseline to 11.47, 8.22, and 11.23. Along with that, the cognitive functioning improved significantly after the 6^th session and 12^th session in which particularly the short term recall function improved. Hence, it has to be mentioned that the authors in this article could establish the fact that group music intervention is a non-invasive and inexpensive therapy that can reduce not just the depression symptoms in the older adults but can also delay the deterioration of the cognitive functioning, especially for short term recalling. Short duration of treatment and lack of long-term follow-up along with resource limitation had been weaknesses of the study which limited the generalizability of the results (Chu et al. 2014)

The third article chosen for the review is by Livingston et al. (2014) that emphasized on the fact that music therapy functioned as the best and most cost effective non-pharmacological intervention technique that can improve the behavioural symptoms in the older dementia patients significantly, especially agitation. This particular randomized control trial focussed systematically reviewing the available RCT evidences available to judge the efficiency of the various different non-pharmacological intervention in reducing the symptoms if agitation among the older dementia patients. The authors reviewed 33 article and the data findings indicated at the fact that music therapy helped in improvement of behavioural symptoms of agitation among the older adults with the SES range of 0.5–0.6 reduced the agitation levels in the patients with dementia with decreasing the sensory intervention as well. Although the first article reviewed contradicts the impact of music therapy on agitation in the older adults and as the article by Livingston et al. (2014)

Suitable Search Strategies

Lastly article by Fu, Moyle and Cooke (2013) to be reviewed focuses on the impact of touch therapy such as massage and the impact of sensory stimulation to improve the disruptive behavioural disorder among the dementia patients. The single blinded randomized control trial which is by far the highest and most reliable level of evidence in literature involved 67 participants and randomly assigned into a control and 2 experimental groups that received two separate interventions (aromatherapy and hand message and only aromatherapy) and placebo control. The results indicated that both of the interventions are incapable of facilitating substantial effects on reducing the disrupted behaviours (Fu, Moyle and Cooke 2013).

Hence, summarizing the key themes identified and discussed, the impact of music therapy in different settings and formats have been proven to be exponentially effective in reducing not just the behavioural symptoms but also delaying and prolonging the progressive cognitive dis-functionality. On the other hand the article on touch therapy indicated this intervention to be more or less ineffective in facilitating any considerable impact on the behavioural symptoms of the target group. Along with that, in contrast of the mounting evidence regarding the effectiveness of the music therapy on the target groups, there are scarce relevant and reliable evidences available on touch therapy and its use, and the only relevant article identified for this review indicated at the inefficiency of the touch therapy in decreasing the behavioural symptoms such as agitation, anxiety and depression among older dementia patients. Hence, music therapy is more effective and inexpensive non-pharmacological technique that can be followed to reduce these behavioural symptoms among the patients.

Conclusion

In conclusion it can be said that complementary therapies provide much benefit in comparison to the pharmacological interventions. A large number of evidences have been found supporting the effectiveness of music therapy in the dementia patients over touch therapy in reducing anxiety in the elderly patients. However very less number of articles have been found in relation to touch therapy for the dementia patients. Based on this findings, recommendations such as grouped music therapy or music classes specifically for the dementia patients in the community care setting can be introduced.

References

Aigen, K., 2015. A critique of evidence-based practice in music therapy. Music Therapy Perspectives, 33(1), pp.12-24.

Chu, H., Yang, C.Y., Lin, Y., Ou, K.L., Lee, T.Y., O’Brien, A.P. and Chou, K.R., 2014. The impact of group music therapy on depression and cognition in elderly persons with dementia: a randomized controlled study. Biological research for Nursing, 16(2), pp.209-217.

Fu, C.Y., Moyle, W. and Cooke, M., 2013. A randomised controlled trial of the use of aromatherapy and hand massage to reduce disruptive behaviour in people with dementia. BMC complementary and alternative medicine, 13(1), p.165.

Livingston, G., Kelly, L., Lewis-Holmes, E., Baio, G., Morris, S., Patel, N., Omar, R.Z., Katona, C. and Cooper, C., 2014. Non-pharmacological interventions for agitation in dementia: systematic review of randomised controlled trials. The British Journal of Psychiatry, 205(6), pp.436-442.

Parahoo, K., 2014. Nursing research: principles, process and issues. Palgrave Macmillan.

Ridder, H.M.O., Stige, B., Qvale, L.G. and Gold, C., 2013. Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging & mental health, 17(6), pp.667-678.

Sung, H.C., Lee, W.L., Li, T.L. and Watson, R., 2012. A group music intervention using percussion instruments with familiar music to reduce anxiety and agitation of institutionalized older adults with dementia. International journal of geriatric psychiatry, 27(6), pp.621-627.

Vasionyt?, I. and Madison, G., 2013. Musical intervention for patients with dementia: a meta?analysis. Journal of clinical nursing, 22(9-10), pp.1203-1216.